Major Award from NIA and Related Dementia Research Viewed Through Geriatric Prism

An estimated 6 million Americans are living with Alzheimer’s disease – a number that is projected to rise to more than 13 million by 2050, according to the latest data from the Alzheimer’s Association.

“This [increase] is absolutely related to the aging population,” explains Ardeshir Hashmi, MD, Section Chief of the Cleveland Clinic Center for Geriatric Medicine. “Older adults who are non-Hispanic, African American or Hispanic are at greater risk of having Alzheimer’s disease than Caucasians,” he adds. Interestingly, the disease also disproportionately affects women, who comprise approximately two-thirds of all patients with the diagnosis.

Because the disease severely compromises cognitive function, most Alzheimer’s patients become high utilizers of healthcare services, and many require 24/7 care. In 2021, the cumulative financial burden of Alzheimer’s disease and other disorders associated with dementia in the US was an estimated $355 billion. As the incidence of these devastating disorders continues to grow, their financial toll is expected to rise to more than $1.1 trillion by 2050. With this in mind, geriatricians like Dr. Hashmi are invested in facilitating collaborative research aimed at identifying novel effective therapies.

NIH grant unites experts with a common mission

In August 2021 the Cleveland Alzheimer’s Disease Research Center announced a five-year $15.4 million award from the National Institute on Aging of the National Institutes of Health. The award will serve to support the Center’s research initiatives and a multi-institution collaborative aimed at accelerating research for Alzheimer’s disease and related dementias. Participating institutions include Administrative, Biomarkers, Clinical, Data Management and Statistics, Neuropathology, Outreach, Recruitment and Engagement, Research Education, Translational Therapeutics, and Neuroimaging Core.

Cleveland Clinic’s geriatrics program stands to significantly benefit from the research incentives funded by the grant, Dr. Hashmi says.

“There are two questions that can be viewed through the geriatrics prism,” he explains. “One asks how patients can benefit from digital and biological markers capable of detecting Alzheimer’s disease and other types of dementia early. We are talking about the ability to perceive changes in the brain and cerebrospinal fluid maybe even 20 years before patients or their families notice any signs of memory change.

“The other question asks how alternative pathophysiological paradigms and treatments can be used most effectively. How can we apply lifestyle-based interventions that address the risk factors for Alzheimer’s dementia – both within and outside of the brain? The answers to these questions are particularly pressing given the fact that 30 years of research based on the amyloid hypothesis have failed to find a cure for the disease,” says Dr. Hashmi.

He notes that although the five medications currently available to treat Alzheimer’s may decrease the rate of disease progression, they cannot stop the disease entirely or reverse the damage it causes.

Addressing factors that influence Alzheimer’s disease

Dr. Hashmi’s team is working proactively to identify patients interested in participating in the planned trials —specifically, those who have a family history of Alzheimer’s or are interested in actively preventing or being monitoring for the development of disease. Study subjects will be recruited from the department’s Successful Aging Program, which follows individuals 50 years or older.

In treating patients with dementia and Alzheimer’s disease, it is important to treat any related comorbidities and address any lifestyle factors that may influence memory, Dr. Hashmi says. Studies have shown that lifestyle interventions, including diet modifications, exercise and socialization, can positively affect memory. Furthermore, increasing evidence points to the benefit of treating any related comorbidities, including sleep disorders (e.g., sleep apnea and restless leg syndrome), depression, diabetes, and auditory and ophthalmologic disorders. Exploring the connection between hearing and vision and memory is already underway at Cleveland Clinic.

“With our colleagues in audiology, we’re also evaluating hearing to see how memory improves over time when any deficits are treated,” he says.

In addition, the geriatrics program aims to assist strained caregivers who are suffering from the stress of looking after patients with dementia. This includes providing guidance to both patients and caregivers about behavioral manifestations of the disease, such as wandering and hallucinations. The program can also help patients and their families transition to different levels of care, assist with financial planning, arrange home healthcare services, and facilitate discussions about difficult subjects such as driving.